Transcript Structural vs Functional Approach in Musculoskeletal Pathologies

Structural vs Functional
Approach in
Musculoskeletal
Pathologies
June 1st , 2013
9:15-10:30 AM
Dr. Alban Merepeza BA. D.C.
www.porthopehealthcentre.com
Port Hope Ontario.
What is the difference between
structural and functional
pathologies?
How do you diagnose and treat
them?
Why is it important that we (and
you) understand both?
Finally we will cover some specific
cases of these two kinds of
pathologies.
Dr. Vladimir Janda MD (1923-2002)
Czech neurologist
Observed two schools of thought in
musculoskeletal medicine:
Traditional structural approach based on
anatomy and biomechanics..
and
Functional approach is based on
understanding of the function of structures
and how they relate to each other in a
system.
Structural pathologies are damages
to any anatomical structure.
Ex. A muscle tear on the bicep muscle
during a bicep curl, a tear on the
hamstring muscles during sprinting, a
fracture of the femur during a collision in a
football game, a sprain of the ligaments
on a ankle roll over ect.
Orthopaedic medicine is influenced and
guided by a structural approach to
pathologies.
It relies heavily on visualization of the
structures through imagery such as xrays, diagnostic ultrasound, MRI and CT
Scans.
Clinicians then focus their treatment on
repairing these damaged structures.
This is done through immobilization (to
allow healing), surgery and rehabilitation
(exercises).
The structural approach is the foundation of
medical education and practice.
In some cases however many of the
diagnostic tests are inconclusive or
negative for structural lesions (damage).
The clinicians in these cases have
difficulties on coming up a diagnosis.
More likely the cause of lesions then is
functional.
Dr. Janda defined functional
pathologies as impairment in the
ability of a structure or
physiological to perform its
function.
These type of pathologies are more difficult to
detect and diagnose.
This is not visualised through diagnostic imaging.
MRI, x-rays US do not show structural damage.
Clinicians must visualise and understand the
dysfunction by analyzing the complex
interaction of the structures and systems.
Structural or Functional?
Chronic shoulder pain due to subacromial
impingement is a common complaint.
This pathology can be structural (primary) or
functional (secondary).
.
Structurally this can be caused by bony
structures such as subacromial spurs
(bony projections from the acromion),
osteoarthritis spurs on the
acromioclavicular joint, and variations in
the shape of the acromion.
These structural abnormalities reduce the
space under the acromion and cause an
impingement of the rotator cuff soft tissues
causing pain.
Structural approach to treatment in this case
is to repair the damaged structure through
surgery.
Ex. -Remove the hooked acromion or
remove the subacromion spurs.
-Repair a torn rotator cuff.
What if patients has subacromial
impingement but x-rays, MRI, US are all
negative?
In this case it is a Functional subacromial
impingement .
There is typically weakness on the scapular
muscle stabilizers and/or muscle
imbalance which causes aberrant
movement and impingement as a result.
This requires a good understanding of the
function and biomechanics of the shoulder
and the approach to treatment is
significantly different from the structural
approach.
As you can see this structural and
functional pathology of the shoulder
presents differently and should be treated
differently.
This understanding of the difference
between the two is essential for clinicians’
success. The clinicians who fail to employ
both approaches to their practice are
doomed to fail.
Other functional pathologies explained.
Jumper’s knee
Osgood-Schlatter Disease
Plantar Fasciitis
Lower-Cross Syndrome
Upper-Crossed Syndrome
Iliotibial Band Syndrome
Why do you need to know ?
Because you are at the front line.
Often the first professionals to notice
pathologies. Therefore refer to the right
professionals for care.
There is a time for “no pain no gain” and there is
a time that you might need to modify your
exercise, change intensity, duration and maybe
try different kind of exercise.
Thank you !